One & Done

Imagine: A woman is diagnosed with breast cancer — and treated for it — in a single visit. No surgery required. Two Cleveland Clinic researchers are working to make this a reality.

>> Someday, in the near future …

A woman’s MRI reveals breast cancer. But instead of being sent home with the diagnosis weighing on her and her loved ones for weeks, or months, while awaiting treatment, she has the cancer treated — completely eradicated, actually — during that very same visit to the doctor.

All without surgery or serious side effects.

This all-in-one approach is a dream of surgeon Stephen Grobmyer, MD, Director of Breast Services at Cleveland Clinic. Imaging technology has improved so much in recent years, he says, that it would be a shame not to pair it with treatment in real time.

“We should be using imaging to guide treatment,” Dr. Grobmyer says. “The idea is that you have an image that will tell you whether something is cancer, and then you flip the switch or turn on the light and destroy the tumor.”

The second part of this scenario is easier said than done — but could become a reality thanks to his collaboration with Vijay Krishna, PhD, a biomedical researcher in Cleveland Clinic’s Department of Biomedical Engineering.

Every 2 minutes, a woman in the United States
is diagnosed with breast cancer.

Non-Invasive, Localized Treatment

>> Their work takes full advantage of the unique properties of nanotechnology — an emerging field that uses particles invisible not only to the naked eye, but also to most microscopes. Although the scale is small, the promise is enormous.

In their case, they work with molecules known as polyhydroxy fullerenes (PHF), which are among the smallest of the small at 1.3 nanometers. Dr. Krishna discovered that PHF generates heat with the use of low-intensity lasers, which could prove useful in cancer treatments that produce heat in tumors to destroy them. Current treatments are effective, but also invasive, painful and produce side effects because they require surgery or chemotherapy.

PHF may change that.

“We could inject PHF into the tumor and then shine the laser from outside the body, since we can use a near-infrared laser to penetrate the tissue a few centimeters deep,” Dr. Krishna says. “And we can restrict the treatment to the tumor only, so the healthy tissue isn’t damaged in any way.”

In lab studies using this technique, tumors decreased in size by half within just two hours. The photothermal properties do much of the work, but sound matters, too: Shining a light on PHF generates acoustic shock waves, which help break up tumor tissue.

The Power of Thinking Small

>> Combine heat and sound, and PHF could become a powerhouse: Because it works with so many light frequencies, it could reach forms of cancer located deep within the body.

And the possibilities don’t end there.

“PHF has been developed independently as an MRI contrast agent, and it’s a very, very good one,” Dr. Grobmyer says. “Clinicians could use it to guide treatment — and confirm in real time whether the treatment is working.”

What does that mean exactly? That PHF could be used to search and destroy: giving us clear pictures of suspicious areas while, at the same time, eradicating any tumor tissue that’s found — immediately, precisely and noninvasively.

“Philanthropic funding would allow us to engineer multifunctional nanotechnologies that could lead not only to combined diagnosis and treatment,” Dr. Krishna says, “but also to preventing cancer.”

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